While diet and exercise are available to all, bariatric surgery is likely to remain a solution available to just a small fraction of the 90 million Americans who are obese. But when it comes to inducing weight loss and improving obesity-related health conditions, a new study has found that there really is no contest between the two: Procedures such as gastric bypass, sleeve gastrectomy and gastric banding beat diet and exercise. By a long shot.

A new study published Tuesday in the British Medical Journal finds that among subjects followed for at least six months and as long as two years, those who got weight-loss surgery lost on average 57 more pounds than those in nonsurgical weight programs. They were 22 times more likely to see their Type 2 diabetes abate and almost 2 1/2 times more likely to show improvements in signs of metabolic syndrome (a cluster of measures, including abdominal obesity, high fasting blood sugar, hypertension, high triglycerides and low levels of LDL, or bad cholesterol).

Clinical trial subjects who were asked to rate their quality of life after bariatric surgery generally reported greater improvement than those who participated in nonsurgical weight loss programs, although these findings were more muted than those focused on easier-to-measure outcomes.

When the adverse side effects of the two treatments were compared, diet and exercise programs looked a little better: Subjects in nonsurgical weight-loss programs didn't have the re-operations that were necessary for a sizable minority of bariatric surgery patients, or the postoperative pneumonia that afflicted a very small number of those who got surgery. But they were more likely to become depressed, more likely to have inflammation of the gallbladder, and about as likely to develop iron-deficiency anemia.

The latest research is a meta-analysis -- a compilation of studies that aims to collect all of the well-designed clinical trails on a given subject and distill their collective findings. In recent years, the benefits of bariatric surgery, including its ability to swiftly reduce the need for diabetes medications, have been mounting.

Despite an initial pricetag of $20,000-25,000 and (for many) additional postoperative expenses, bariatric surgery has grown 16-fold over the last 15 years, with an average of 220,000 such procedures done each year. While weight-loss surgery is certain to increase in coming years, some studies already have asked whether it's worth the cost.

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